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European Journal of Trauma and... Aug 2019The aim of this systematic review and meta-analysis was to present current evidence on rib fixation and to compare effect estimates obtained from randomized controlled... (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim of this systematic review and meta-analysis was to present current evidence on rib fixation and to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies.
METHODS
MEDLINE, Embase, CENTRAL, and CINAHL were searched on June 16th 2017 for both RCTs and observational studies comparing rib fixation versus nonoperative treatment. The MINORS criteria were used to assess study quality. Where possible, data were pooled using random effects meta-analysis. The primary outcome measure was mortality. Secondary outcome measures were hospital length of stay (HLOS), intensive care unit length of stay (ILOS), duration of mechanical ventilation (DMV), pneumonia, and tracheostomy.
RESULTS
Thirty-three studies were included resulting in 5874 patients with flail chest or multiple rib fractures: 1255 received rib fixation and 4619 nonoperative treatment. Rib fixation for flail chest reduced mortality compared to nonoperative treatment with a risk ratio of 0.41 (95% CI 0.27, 0.61, p < 0.001, I = 0%). Furthermore, rib fixation resulted in a shorter ILOS, DMV, lower pneumonia rate, and need for tracheostomy. Results from recent studies showed lower mortality and shorter DMV after rib fixation, but there were no significant differences for the other outcome measures. There was insufficient data to perform meta-analyses on rib fixation for multiple rib fractures. Pooled results from RCTs and observational studies were similar for all outcome measures, although results from RCTs showed a larger treatment effect for HLOS, ILOS, and DMV compared to observational studies.
CONCLUSIONS
Rib fixation for flail chest improves short-term outcome, although the indication and patient subgroup who would benefit most remain unclear. There is insufficient data regarding treatment for multiple rib fractures. Observational studies show similar results compared with RCTs.
Topics: Aged; Conservative Treatment; Critical Care; Female; Flail Chest; Fracture Fixation; Humans; Length of Stay; Male; Middle Aged; Observational Studies as Topic; Pneumonia; Randomized Controlled Trials as Topic; Respiration, Artificial; Rib Fractures; Tracheostomy
PubMed: 30276722
DOI: 10.1007/s00068-018-1020-x -
Pediatric Emergency Care Feb 2019We aimed to estimate the prevalence of abuse in young children presenting with rib fractures and to identify demographic, injury, and presentation-related...
OBJECTIVES
We aimed to estimate the prevalence of abuse in young children presenting with rib fractures and to identify demographic, injury, and presentation-related characteristics that affect the probability that rib fractures are secondary to abuse.
METHODS
We searched PubMed/MEDLINE and CINAHL databases for articles published in English between January 1, 1990, and June 30, 2014 on rib fracture etiology in children 5 years or younger. Two reviewers independently extracted predefined data elements and assigned quality ratings to included studies. Study-specific abuse prevalences and the sensitivities, specificities, and positive and negative likelihood ratios of patients' demographic and clinical characteristics for abuse were calculated with 95% confidence intervals.
RESULTS
Data for 1396 children 48 months or younger with rib fractures were abstracted from 10 articles. Among infants younger than 12 months, abuse prevalence ranged from 67% to 82%, whereas children 12 to 23 and 24 to 35 months old had study-specific abuse prevalences of 29% and 28%, respectively. Age younger than 12 months was the only characteristic significantly associated with increased likelihood of abuse across multiple studies. Rib fracture location was not associated with likelihood of abuse. The retrospective design of the included studies and variations in ascertainment of cases, inclusion/exclusion criteria, and child abuse assessments prevented further meta-analysis.
CONCLUSIONS
Abuse is the most common cause of rib fractures in infants younger than 12 months. Prospective studies with standardized methods are needed to improve accuracy in determining abuse prevalence among children with rib fractures and characteristics associated with abusive rib fractures.
Topics: Child Abuse; Child, Preschool; Female; Humans; Infant; Male; Prevalence; Rib Fractures; Sensitivity and Specificity
PubMed: 27749806
DOI: 10.1097/PEC.0000000000000911 -
Clinical Journal of Sport Medicine :... Jan 2021The use of local anesthetic painkilling injections to improve player availability is common practice in elite-level sport.
BACKGROUND
The use of local anesthetic painkilling injections to improve player availability is common practice in elite-level sport.
OBJECTIVE
To document the published use of local anesthetic injections in sport, according to number of injections, sites of injections, and complications reported.
DATA SOURCES
A systematic search of MEDLINE, Embase, CINAHL, AMED, Cochrane Database of Systematic reviews, SportDiscus, EBSCO Host, and Google Scholar.
RESULTS
One thousand nine hundred seventy local anesthetic injections reported on 540 athletes in 10 studies (from rugby league, American football, Australian football, and soccer) were reviewed. The most common areas of injection were as follows: the acromioclavicular (AC) joint; hand (including fingers); sternoclavicular joint (including sternum); rib injuries; and iliac crest contusions.
DISCUSSION
This review found some evidence of long-term safety for a limited number of injection sites (eg, AC joint) and some evidence of immediate complications and harmful long-term consequences for other sites. The quality of evidence is not high, with little long-term data and a lack of independent verification of the effects of the injections. Ideally, long-term follow-up should be conducted to determine whether these injections are safe, with follow-up undertaken independently of the treating physician and team.
CONCLUSIONS
Based on limited publications, there is some evidence of long-term safety; however, there is a lack of clear proof of either absolute safety or long-term harm for many of these procedures. Physicians and players in professional sport should proceed with caution in using local anesthetic injections.
Topics: Anesthetics, Local; Athletes; Humans; Injections; Pain Management
PubMed: 30789366
DOI: 10.1097/JSM.0000000000000716 -
Cureus Jan 2024Rib fractures, common among trauma victims, lead to significant morbidity and mortality. Managing the associated pain is challenging, with IV opioids and thoracic... (Review)
Review
Rib fractures, common among trauma victims, lead to significant morbidity and mortality. Managing the associated pain is challenging, with IV opioids and thoracic epidural analgesia (TEA) being utilized. While epidural analgesia is often preferred for fractured rib pain, existing data encompasses both lumbar and thoracic approaches. This review aimed to compare TEA and IV opioids for persistent rib fracture pain. A comprehensive search across five databases yielded 987 articles, of which seven met the eligibility criteria. Outcomes were categorized into primary (pain reduction) and secondary (mortality, hospital/ICU stays, analgesia-related complications) endpoints. Analyzed with Review Manager (RevMan) Version 5.4.1 (2020; The Cochrane Collaboration, London, United Kingdom), the pooled data from two sources showed TEA significantly more effective in reducing pain than IV opioids (standardized mean difference SMD): 2.23; 95%CI: 1.65-2.82; p < 0.00001). Similarly, TEA was associated with shorter ICU stays (SMD: 0.73; 95%CI: 0.33-1.13; p = 0.0004), while hospitalization duration showed no substantial difference (SMD: 0.82; 95%CI: -0.34-1.98). Mortality rates also did not significantly differ between TEA and IV opioids (risk ratio (RR): 1.20; 95%CI: 0.36-4.01; p = 0.77). Subgroup analysis revealed fewer pneumonia cases with TEA (RR: 2.06; 95%CI: 1.07-3.96; P = 0.03), with no notable disparities in other complications. While TEA's superiority in pain relief for rib fractures suggests it is the preferred analgesic, the recommendation's strength is tempered by the low methodological quality of supporting articles.
PubMed: 38318591
DOI: 10.7759/cureus.51740 -
Healthcare (Basel, Switzerland) Nov 2022The assessment of posture and asymmetries is common in musculoskeletal clinical practice, and correction is a frequent goal. In this setting, posture and asymmetries are... (Review)
Review
The assessment of posture and asymmetries is common in musculoskeletal clinical practice, and correction is a frequent goal. In this setting, posture and asymmetries are usually interpreted in terms of musculoskeletal issues. This study aimed to evaluate spinal asymmetries in case studies of unilateral nephroptosis. A systematic review was performed using PubMed, CINAHL, Scopus and Web of Science. We included case reports and case series of nephroptotic patients which showed diagnostic imaging that allowed us to assess the presence of spinal asymmetries in the frontal plane. The methodological quality of the selected studies was assessed by using Case Report (CARE) checklist. Nineteen studies were included, with a total number of 78 reported patients (69 women) ranging 22 to 44 years old (mean: 29). Only one patient presented with medial nephroptosis, while the rest presented with caudal migration. Ninety-one percent of the cases affected to the right kidney. All cases but two showed homolateral flank closure (lower rib descent, iliac crest raise and/or homolateral side-bending). The correction of nephroptosis, either by supine position or surgical treatment, removed asymmetries in some cases while other cases improved only partly. Manual therapists must consider visceral implications while assessing body posture. Further, since the most common symptom of nephroptosis is loin pain, and it has been claimed that loin pain is underdiagnosed, manual therapists should consider its potential presence during clinical practice. Finally, being that nephroptosis shares several features with idiopathic lumbar scoliosis (type of patient, postural adaptation), more research is needed regarding any possible relation between them.
PubMed: 36553946
DOI: 10.3390/healthcare10122422 -
Cancer Treatment Reviews Nov 2022Hypofractionated proton beam radiotherapy (PBT) is gaining attention in early-stage non-small cell lung cancer (ES-NSCLC). However, there is a large unmet need to define... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hypofractionated proton beam radiotherapy (PBT) is gaining attention in early-stage non-small cell lung cancer (ES-NSCLC). However, there is a large unmet need to define indications, prescription doses and potential adverse events of protons in this clinical scenario. Hence, the present work aims to provide a critical literature revision, and to investigate associations between fractionation schedules/ biological effective doses (BEDs), oncological outcomes and toxicities.
MATERIALS AND METHODS
This systematic review and meta-analysis complied with the PRISMA recommendations. Inclusion criteria were: 1) curative-intent hypofractionated PBT for ES-NSCLC (≥3 Gy(RBE)/fraction), 2) report of the clinical outcomes of interest, 3) availability of full-text written in English. The bibliographic search was performed on the NCBI Pubmed, Embase and Scopus in September 2021; no other limitations were applied. The BED was calculated for each included study (α/β = 10 Gy); the median BED for all studies was used as a threshold for stratifying selected evidence into "high" and "low"-dose subgroups. Heterogeneity was tested using chi-square statistics; inconsistency was measured with the I index. Pooled estimate was obtained by fitting both the fixed-effect and the DerSimonian and Laird random-effect model.
RESULTS
Eight studies and 401 patients were available for the meta-analysis; median follow-up was 32.8 months. The median delivered BED was 105.6 Gy(RBE). A BED ≥ 105.6 Gy(RBE) consistently provided superior OS, CSS, DFS and LC rates (i.e.: 4-year OS: 0.56 [0.34-0.76] for BED < 105.6 Gy(RBE) and 0.78 [0.64-0.88] for BED ≥ 105.6 Gy(RBE)). The meta-analysis of proportions showed a comparable probability of developing acute grade ≥ 2 toxicity between the two groups, while the probability of any late grade ≥ 2 event was almost three-times greater for BED ≥ 105.6 Gy(RBE), with rib fractures being more common in the high dose group.
CONCLUSION
Hypofractionated PBT is a safe and effective treatment option for ES-NSCLC; the delivery of BED ≥ 105.6 Gy(RBE) with advanced techniques for uncertainty management has been associated with improved oncological outcomes across all considered time points.
Topics: Carcinoma, Non-Small-Cell Lung; Dose Fractionation, Radiation; Humans; Lung Neoplasms; Proton Therapy; Protons
PubMed: 36194908
DOI: 10.1016/j.ctrv.2022.102464 -
Physical Therapy Jan 2022The purposes of this study were to evaluate the effect of positive expiratory pressure (PEP) therapy on lung volumes and health outcomes in adults with chest trauma and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purposes of this study were to evaluate the effect of positive expiratory pressure (PEP) therapy on lung volumes and health outcomes in adults with chest trauma and to investigate any adverse effects and optimal dosages leading to the greatest positive impact on lung volumes and recovery.
METHODS
Data sources were MEDLINE/PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database, CINAHL, Open Access Thesis/Dissertations, EBSCO Open Dissertations, and OpenSIGLE/Open Grey. Randomized controlled trials investigating PEP therapy compared with usual care or other physical therapist interventions were included. Participants were >18 years old and who were admitted to the hospital with any form of chest trauma, including lung or cardiac surgery, blunt chest trauma, and rib fractures. Methodological quality was assessed using the Physiotherapy Evidence Database Scale, and the level of evidence was downgraded using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Eleven studies involving 661 participants met inclusion eligibility. There was very low-level evidence that PEP improved forced vital capacity (standardized mean difference = -0.50; 95% CI = -0.79 to -0.21), forced expiratory volume in 1 second (standardized mean difference = -0.38; 95% CI = -0.62 to -0.13), and reduced the incidence of pneumonia (relative risk = 0.16; 95% CI = 0.03 to 0.85). Respiratory muscle strength also significantly improved in all 3 studies reporting this outcome. There was very low-level evidence that PEP did not improve other lung function measures, arterial blood gases, atelectasis, or hospital length of stay. Both PEP devices and dosages varied among the studies, and no adverse events were reported.
CONCLUSION
PEP therapy is a safe intervention with very low-level evidence showing improvements in forced vital capacity, forced expiratory volume in 1 second, respiratory muscle strength, and incidence of pneumonia. It does not improve arterial blood gases, atelectasis, or hospital length of stay. Because the evidence is very low level, more rigorous physiological and dose-response studies are required to understand the true impact of PEP on the lungs after chest trauma.
IMPACT
There is currently no strong evidence for physical therapists to routinely use PEP devices following chest trauma. However, there is no evidence of adverse events; therefore, in specific clinical situations, PEP therapy may be considered.
Topics: Adult; Humans; Lung Injury; Lung Volume Measurements; Outcome Assessment, Health Care; Positive-Pressure Respiration; Randomized Controlled Trials as Topic; Respiratory Therapy; Thoracic Injuries
PubMed: 34723337
DOI: 10.1093/ptj/pzab254 -
The Physician and Sportsmedicine Jun 2022(1) To report the distribution of injuries per body site and time lost from participation in female NCAA Division I rowers and (2) to present an updated summary of the... (Review)
Review
OBJECTIVES
(1) To report the distribution of injuries per body site and time lost from participation in female NCAA Division I rowers and (2) to present an updated summary of the existing evidence regarding the analysis of injuries per body site in rowers.
METHODS
Case series: The distribution of injuries per body site in female NCAA Division I rowers and the time lost from participation were retrieved from an institutional registry. Injuries per body site were reported as number of athletes with site-specific injury per total number of injured athletes. Systematic review: Based on the PRISMA guidelines for systematic reviews, three electronic databases were searched for studies reporting the epidemiology of injuries per body site in rowers and analyzed.
RESULTS
Case series: One-hundred and thirty-seven injuries were recorded in 92 female rowers over 5 years. The risk of injury (number of injured athletes over total number of athletes on roaster) was 52% (92/176). Among the 92 injured athletes, 38% sustained injury to the lower back, while 23% and 16% of these athletes sustained injury to the ribs and hip-groin area, respectively. Systematic review: Ten studies were included. The level of evidence was IV and the mean MINORS score was 13.2(9-15) (fair quality). Most studies reported injuries to the lower spine (8/10,80%) whereas injuries to the ribs or other anatomic sites were reported in ≤4 (40%) studies. Significant heterogeneity of the injury reporting methodologies (injury definition; measures of injury occurrence; description of the injury site) was detected and precluded meta-analysis.
CONCLUSIONS
Most injuries recorded in a single team of female NCAA Division I athletes occurred in the lower back followed by injuries to the ribs and the hip. The existing injury epidemiology literature in mostly focuses on injuries to the lower back, while injuries to other anatomic sites were less frequently analyzed. No conclusions can be made regarding the most common injuries in rowers based on the current evidence due to substantial heterogeneity of injury reported methodologies which warrants further investigation.
Topics: Athletes; Athletic Injuries; Female; Humans; Ribs; Universities; Water Sports
PubMed: 34000208
DOI: 10.1080/00913847.2021.1931526 -
Frontiers in Neurology 2022Many publications report outcomes of surgical treatment for neurothoracic outlet syndrome (NTOS); however, high-quality meta-analyses regarding objective evaluation...
OBJECTIVE
Many publications report outcomes of surgical treatment for neurothoracic outlet syndrome (NTOS); however, high-quality meta-analyses regarding objective evaluation system accessing the long-term outcome of NTOS are lacking. This meta-analysis summarizes and compares the outcomes of Derkosh's classification and vas visual analog scale of the supraclavicular neuroplastic of brachial plexus (SNBP) and trams auxiliary first rib resection (TFRR).
METHODS
The Cochrane Library, PubMed, EMBASE, Allied and Complementary Medicine (AMED) were searched for papers published between January 1980 and February 2021, using the keywords "thoracic outlet syndrome," "treatment, surgical." Articles were eligible for inclusion if the following criteria were met studies describing outcomes of surgery for NTOS, published in English, human studies, and available in full text. The exclusion criteria were case reports ( < 10), reviews, abstracts, and studies lacking a control group or without evaluation for two types of surgery.
RESULTS
We included 10 studies with 1,255 cases, out of which 622 were in the SNBP group; and 633 were in the TFRR group. After surgery (≥12 months), Derkash's classification was improved in 425 cases with SNBP and 364 cases with TFRR. OR = 1.34 (95% CI: 0.94, 1.92), = 0.03; vas visual analog scale was improved in 282 cases in the SNBP group and 214 cases in the TFRR group. OR = 1.08 (95% CI: 0.63, 1.85), = 0.78.
CONCLUSION
This meta-analysis shows that both SNBP and TFRR are effective for NTOS, but that SNBP is better than TFRR in improving Derkash's classification in the long term. Although patients treated with SNBP are more satisfactory, there is no significant difference in vas visual analog scale from TFRR.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021254203, PROSPERO CRD42021254203.
PubMed: 35873776
DOI: 10.3389/fneur.2022.899120 -
Healthcare (Basel, Switzerland) Jan 2023The number of patients with post-COVID-19 syndrome continues to increase considerably, having serious healthcare, social and economic repercussions. The objective of... (Review)
Review
The number of patients with post-COVID-19 syndrome continues to increase considerably, having serious healthcare, social and economic repercussions. The objective of this study is to describe the effectiveness of telerehabilitation to alleviate the symptoms of post-COVID-19 syndrome. A systematic review was conducted using the information available on four databases (PubMed, Medline, Scielo and PEDRo) on these patients until November 2022. The MeSH search terms were: Post-COVID syndrome, Post-COVID-19, Long COVID, Telerehabilitation, Physiotherapy, Rehabilitation, Virtual, Home care. Six articles were included which provided information on 140 patients, detailing their symptomatology, assessment, treatment and monitoring. The variables measured were dyspnea, fatigue, physical performance and quality of life. All studies included aerobic and anaerobic exercises. Most notable among the techniques used were rib cage expansion exercises, respiratory control and thoracic cage stretching, patient education, Mindfulness and virtual reality games to address physical, mental and relaxation aspects. The use of telerehabilitation could be an effective tool for the treatment of persistent symptoms after suffering from COVID-19. It has been shown in these studies that patients improve both their physical performance and their quality of life.
PubMed: 36673555
DOI: 10.3390/healthcare11020187